Emerging evidence suggests that patient-centered communication practices are essential to the delivery of high quality, reliable and safe patient care. However, despite trials demonstrating the efficacy of specific patient-centered communication strategies, implementation of practices within healthcare systems is poor. A reason may be that an organization does not prioritize or support patient-centered communication practices. Advancing research to determine the relationship between organizational patient-centered communication climate and patient outcomes is critical to demonstrate its value and to identify mechanisms whereby modifying organizational patient-centered communication climate will have the most impact. The goal of this proposal is to advance understanding of the practices, determinants and associated patient outcomes of organizational patient-centered communication climate. End-stage renal disease (ESRD) and the provision of life-sustaining dialysis treatment provides a unique and robust setting to examine organizational communication climate. Patients with ESRD are at significantly higher risk for mortality, hospitalization, and poor quality of life. Despite advances in the technology o dialysis care, outcomes are persistently poor indicating the need for novel strategies to improve patient health. We hypothesize that organizational communication climate contributes significantly to individual patient reported and clinical outcomes, and may overcome disparities in outcomes among vulnerable patients. We will leverage the resources of the Dialysis Outcomes and Practice Patterns Study (DOPPS), a representative prospective international cohort study since 1996, in 21 countries, aimed to identify modifiable dialysis practices associated with improved patient outcomes. To address our hypothesis, the aims are: 1) To characterize organizational patient-centered communication climate and its association with patients' satisfaction with provider communication, dialysis knowledge, self-efficacy, and self-care behaviors in 200 dialysis facilities and 1400 patients; 2) To examine in a prospective cohort the association of organizational patient-centered communication climate with clinical outcomes in 465 dialysis facilities and 15,000 patients; and 3) To determine if dialysis facility organizational communication climate modifies associations of age, race, or health-literacy related disparities and outcomes. We are an integrated, diverse research team well equipped and uniquely poised to efficiently leverage existing infrastructure to advance health communication, organizational behavior and dialysis research. This proposal will serve future research by advancing our understanding of mechanisms and impact of organizational communication climate in dialysis care, evaluating a novel framework depicting its role, and also generating efficient assessment methods. This research will further inform the future development and testing of efficient and effective multi-level interventions to connect patients, providers and health systems to optimize quality programs and patient-centered care.